Clinical Care Associate - LPN

Horizon Healthcare Services • Hopewell, NJ

1d

About The Position

The Clinical Care Associate supports field-based Care Managers (RN II and Care Specialist III) and serves as a first point of contact for members seeking service or provider information, as well as members and providers requesting service authorizations or denials. Under the direction and supervision of a Care Manager, the position coordinates and secures health care services included in a member-centered plan of care. The role supports implementation and facilitation of services, member follow-up, education, documentation, telephonic assistance, and issue resolution. Horizon employees in this role must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Requirements

• High school diploma or GED.
• Knowledge of care manager standards of practice, service coordination, and service delivery.
• Strong knowledge of managed care principles and concepts, including Health Plan Effectiveness Data and Information Set (HEDIS).
• Strong organizational skills.
• Strong oral and written communication skills.
• Good PC skills, including experience with a medical management system for electronic medical records and Microsoft Office applications such as Excel, Access, and Word.
• Good problem-solving and conflict-resolution skills.
• Good presentation skills.
• Ability to work with limited daily supervision.

Nice To Haves

• Healthcare industry experience.
• At least one year of experience in home care, discharge planning, or case management, preferably with the elderly frail population.
• At least one year of experience in the managed care industry.

Responsibilities

• Assist with scheduling and coordinating service needs identified in members’ plans of care.
• Help members find health care professionals, locate and coordinate health and safety services, schedule appointments and services, and provide authorizations or, when appropriate, complete denials for care services.
• Assist with implementation and facilitation of services and ensure timely member follow-up.
• Communicate effectively with members by telephone, encourage participation and compliance in the program, and assist with placing calls to members.
• Coordinate high-quality, cost-effective care based on member needs and the managed long-term support and services model, using clinical practice guidelines established by the plan.
• Interact with Care Manager members and their families, physicians, and health care teams.
• Use the care management process to set priorities, plan, organize, and implement goal-directed interventions and member care.
• Provide members with educational information to support their health and well-being.
• Document accurately and comprehensively in accordance with standards of practice and current organizational policies.
• Provide telephonic assistance for program-specific activities and troubleshoot and resolve issues for members and field staff.
• Respond professionally and appropriately to member and provider inquiries received through the CCA phone queue.
• Mail required documents to members and upload returned documents into the medical management system to meet contractual requirements.

Benefits

• Comprehensive health benefits, including medical, dental, and vision coverage.
• Retirement plans.
• Generous paid time off.
• Incentive plans.
• Wellness programs.
• Paid volunteer time off.
• Tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED